Case Study

“Thank You, You Saved My Husband's Life”

A careful examination helped ensure this patient will attend many family reunions.

Sergina M. Flaherty, COMT

“Thank you, you saved my husbands life” This note sits on Dr. Jean Edwards Holt's desk to remind her of a very special time. It's not often we in ophthalmology can play the vital role of saving a life, but one Monday afternoon we saw a 35-year-old male and proceeded to do just that.

Our patient was seen the previous Friday in a Texas MedClinic (a regional urgent care facility) for a 3-day history of “red eye.” He was given allergy eye drops and instructed to see an ophthalmologist if he didn't get any better. Our patient was planning to hit the road for a family reunion, but, after the eye drops did not relieve his symptoms, he called our office and was instructed to come right in.

As the technician, I performed a preliminary examination, as I routinely do. When asking about his history I discovered that, in addition to a red right eye, our patient had suffered 4-days of pain behind the right eye. He also reported a numb feeling on his right forehead, a droopy upper eyelid and a headache. I found his vision to be 20/20 without correction in both eyes and a small right pupil. I left the room and met Dr. Holt in the hallway.

“I think we have a patient with a Horner's syndrome,” I said. For those unfamiliar with Horner's Syndrome, it is not a disease, but rather a group of signs that are indicative of a serious medical problem, such as a stroke or tumor. It generally affects one side of the face with symptoms that include ptosis, red eye, a small pupil and reduced sweating.

Dr. Holt went to see the patient immediately and I followed. She asked me to call the x-ray and lab departments and make arrangements for a chest x-ray and MRI of the head and neck and CBC, Glucose STAT. The patient reminded Dr. Holt and I that he was scheduled to leave town that evening for a family reunion. I made arrangements for the recommended work up stressing the importance of delaying his trip until the following day. He agreed and left the office to go directly to the radiology department and the laboratory for the tests.

The next morning I received a wake-up call from Dr. Holt. She had received reports the night before at home that the chest x-ray was normal, but the MRI had detected tenuous and significant narrowing of the external carotid artery at the cavernous level. A dissection was not excluded. She was scheduled in the operating room for the morning and wanted me to take charge of getting this patient scheduled with a neurosurgeon, “today!”

I arrived to the office and began what was a very challenging morning. I was on the phone with many offices. Some had voicemail for the receptionist and others stated that they could see our patient on Friday. In between speaking with these medical offices, I took calls from our patient and his wife. He insisted on leaving for his family reunion. I asked him to give me some time to make arrangements for him to see a neurosurgeon that morning. I remember telling his wife if he didn't see the neurosurgeon that very day, he may not get a chance to go to any family reunions. I then asked our patient to put the morning news show on television, sit back on his couch, and wait for my call with an appointment time and directions to the neurosurgeon's office.

A neurosurgeon saw our patient late that morning. The neurosurgeon felt the area was suspicious enough for an external carotid artery dissection so he admitted the patient for an arteriogram. This confirmed the diagnosis and an embolization was successfully performed.

Three months later, we received a letter from our patients' neurosurgeon.

“Your patient's dissection has resolved,” it read. “There is a small pseudoaneurysm, but this should not pose any significant stroke risk to him. I will follow up with him in three months with an MRA. I again related to him how lucky he was to have you evaluate him initially and to very promptly identify his problem.”

It is this episode in my long career as a JCAHPO certified ophthalmic medical technologist that I am most proud. This was the first and only time in my career I had seen a patient who had Horner's Syndrome and I was happy I could identify it. It helped save a life. Our patient will be attending many future family reunions and, as for me, I will never forget having had a small hand in making that possible. OP

Sergina M. Flaherty, COMT is a Certified Ophthalmic Medical Technologist at Stone Oak Ophthalmology in San Antonio, Texas. She is owner of Ophthalmic Seminars of San Antonio and conducts instructional seminars to ophthalmic assistants and technicians in Texas and nationally. She is currently the JCAHPO representative on the board of Directors of the Association of Technical Personnel in Ophthalmology (ATPO). Contact Sergina by visiting her website www.ophthalmicseminars.com